TY - JOUR
T1 - Diagnostic usefulness of the ABCD2 score to distinguish transient ischemic attack and minor ischemic stroke from noncerebrovascular events
T2 - The North Dublin TIA study
AU - Sheehan, Orla C.
AU - Merwick, Aine
AU - Kelly, Lisa A.
AU - Hannon, Niamh
AU - Marnane, Michael
AU - Kyne, Lorraine
AU - McCormack, Patricia M.E.
AU - Duggan, Joseph
AU - Moore, Alan
AU - Moroney, Joan
AU - Daly, Leslie
AU - Harris, Dawn
AU - Horgan, Gillian
AU - Kelly, Peter J.
PY - 2009/11
Y1 - 2009/11
N2 - BACKGROUND AND PURPOSE-: Transient ischemic attack (TIA) diagnosis is frequently difficult in clinical practice. Noncerebrovascular symptoms are often misclassified as TIA by nonspecialist physicians. Clinical prediction rules such as ABCD improve the identification of patients with TIA at high risk of early stroke. We hypothesized that the ABCD score may partly improve risk stratification due to improved discrimination of true TIA and minor ischemic stroke (MIS) from noncerebrovascular events. METHODS-: Consecutive patients with TIA were identified within a prospective population-based cohort study of stroke and TIA. The cohort was expanded by inclusion of patients with MIS and noncerebrovascular events referred to a daily TIA clinic serving the population. Diagnosis was assigned by a trained stroke physician independent of ABCD score. RESULTS-: Five hundred ninety-four patients were included (292 [49.2%] TIA, 45 [7.6%] MIS, and 257 [43.3%] noncerebrovascular). The mean ABCD score showed a graded increase across diagnostic groups (MIS mean 4.8 [SD 1.4] versus TIA mean 3.9 [SD 1.5] versus noncerebrovascular mean 2.9 [SD 1.5]; P<0.00001). The ABCD score discriminated well between noncerebrovascular and cerebrovascular events-TIA (c-statistic 0.68; 95% CI, 0.64 to 0.72), any vascular event (TIA+MIS; c-statistic 0.7; 95% CI, 0.66 to 0.74), and MIS (c-statistic 0.81; 95% CI, 0.75 to 0.87)-from noncerebrovascular events. Of ABCD items, unilateral weakness (OR, 4.5; 95% CI, 3.1 to 6.6) and speech disturbance (OR, 2.5; 95% CI, 1.6, 4.1) were most likely overrepresented in TIA compared with noncerebrovascular groups. CONCLUSION-: The ABCD score had significant diagnostic usefulness for discrimination of true TIA and MIS from noncerebrovascular events, which may contribute to its predictive usefulness.
AB - BACKGROUND AND PURPOSE-: Transient ischemic attack (TIA) diagnosis is frequently difficult in clinical practice. Noncerebrovascular symptoms are often misclassified as TIA by nonspecialist physicians. Clinical prediction rules such as ABCD improve the identification of patients with TIA at high risk of early stroke. We hypothesized that the ABCD score may partly improve risk stratification due to improved discrimination of true TIA and minor ischemic stroke (MIS) from noncerebrovascular events. METHODS-: Consecutive patients with TIA were identified within a prospective population-based cohort study of stroke and TIA. The cohort was expanded by inclusion of patients with MIS and noncerebrovascular events referred to a daily TIA clinic serving the population. Diagnosis was assigned by a trained stroke physician independent of ABCD score. RESULTS-: Five hundred ninety-four patients were included (292 [49.2%] TIA, 45 [7.6%] MIS, and 257 [43.3%] noncerebrovascular). The mean ABCD score showed a graded increase across diagnostic groups (MIS mean 4.8 [SD 1.4] versus TIA mean 3.9 [SD 1.5] versus noncerebrovascular mean 2.9 [SD 1.5]; P<0.00001). The ABCD score discriminated well between noncerebrovascular and cerebrovascular events-TIA (c-statistic 0.68; 95% CI, 0.64 to 0.72), any vascular event (TIA+MIS; c-statistic 0.7; 95% CI, 0.66 to 0.74), and MIS (c-statistic 0.81; 95% CI, 0.75 to 0.87)-from noncerebrovascular events. Of ABCD items, unilateral weakness (OR, 4.5; 95% CI, 3.1 to 6.6) and speech disturbance (OR, 2.5; 95% CI, 1.6, 4.1) were most likely overrepresented in TIA compared with noncerebrovascular groups. CONCLUSION-: The ABCD score had significant diagnostic usefulness for discrimination of true TIA and MIS from noncerebrovascular events, which may contribute to its predictive usefulness.
KW - ABCD score
KW - Cerebrovascular disorders
KW - Diagnosis
KW - Transient ischemic attack
UR - http://www.scopus.com/inward/record.url?scp=70350534679&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=70350534679&partnerID=8YFLogxK
U2 - 10.1161/STROKEAHA.109.557074
DO - 10.1161/STROKEAHA.109.557074
M3 - Article
C2 - 19745173
AN - SCOPUS:70350534679
SN - 0039-2499
VL - 40
SP - 3449
EP - 3454
JO - Stroke
JF - Stroke
IS - 11
ER -